坦桑尼亚一家国家转诊医院的实验室确诊产褥期脓毒症：病原体及其对常用处方抗生素的敏感性。
Laboratory confirmed puerperal sepsis in a national referral hospital in Tanzania: etiological agents and their susceptibility to commonly prescribed antibiotics.
机构信息
Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dares Salaam, Tanzania.
出版信息
BMC Infect Dis. 2019 Aug 5;19(1):690. doi: 10.1186/s12879-019-4324-5.
BACKGROUND
In most developing countries, puerperal sepsis is treated empirically with broad spectrum antibiotics due to lack of resources for culture and antibiotics susceptibility testing. However, empirical treatment does not guarantee treatment success and may promote antimicrobial resistance. We set to determine etiological agents and susceptibility pattern to commonly prescribed antimicrobial agents, among women suspected of puerperal sepsis, and admitted at Muhimbili National Hospital.
METHODS
Hospital based cross-sectional study conducted at tertiary hospital from December 2017 to April 2018. The study recruited post-delivery women suspected with puerperal sepsis. Socio- demographic, clinical and obstetric information were collected using structured questionnaire. Blood and endocervical swab samples were collected for aerobic culture. Blood culture bottles were incubated in BACTEC FX40 (Becton-Dickinson, Sparks, MD, USA). Positive blood cultures and cervical swabs were inoculated onto sheep blood agar, MacConkey agar, chocolate agar and Sabouraud's dextrose agar, incubated aerobically at 37 °C for 18-24 h. Antimicrobial susceptibility was determined by Kirby-Bauer disc diffusion method.
RESULTS
A total of 197women were recruited, of whom 50.3% had spontaneous vaginal delivery, while 49.2% had caesarean section. Bacteraemia was detected in 22 (11.2%) women, along with 86 (43.6%) isolated from endocervical swabs. Gram-negative bacilli were the predominant isolates detected in 92(46.7%) cases. Majority of the isolates were E. coli 68(61.8%) followed by Klebsiella spp. 22(20.0%). E. coli were highly susceptible to meropenem (97.0%), while resistance to ceftriaxone, ampicillin and ceftazidime was 64.7, 67.6 and 63.2%, respectively. Klebsiella spp. were susceptible to meropenem (86.4%) and resistant to ceftriaxone (77.3%), gentamicin (86.4%), ampicillin (81.8%) and ceftazidime (86.4%). Staphylococcus aureus isolates were 100% susceptible to clindamycin. The proportion of extended spectrum beta lactamase producers among gram-negative bacilli was 64(69.6%) and 53.8% of S. aureus isolates were resistant to methicillin.
CONCLUSION
In this study puerperal sepsis was mostly caused by E. coli and Klebsiella spp. Causative agents exhibited very high levels of resistance to most antibiotics used in empiric treatment calling for review of treatment guidelines and strict infection control procedures.
背景
在大多数发展中国家，由于缺乏培养和抗生素药敏试验资源，产褥期脓毒症的治疗通常是经验性地使用广谱抗生素。然而，经验性治疗并不能保证治疗的成功，而且可能会促进抗菌药物的耐药性。我们旨在确定在穆希比利国家医院就诊的疑似产褥期脓毒症的女性患者的病原体和常用抗生素的药敏模式。
方法
这是一项 2017 年 12 月至 2018 年 4 月在三级医院进行的基于医院的横断面研究。该研究招募了疑似产褥期脓毒症的产后女性。使用结构化问卷收集社会人口统计学、临床和产科信息。采集血和宫颈拭子样本进行需氧培养。血培养瓶在 BACTEC FX40（Becton-Dickinson，马里兰州斯帕克斯）中孵育。阳性血培养和宫颈拭子接种到绵羊血琼脂、麦康凯琼脂、巧克力琼脂和沙氏葡萄糖琼脂上，在 37°C 下有氧孵育 18-24 小时。采用 Kirby-Bauer 纸片扩散法测定抗生素敏感性。
结果
共招募了 197 名女性，其中 50.3%为自然阴道分娩，49.2%为剖宫产。22 名（11.2%）女性检测到菌血症，86 名（43.6%）从宫颈拭子中分离出细菌。革兰氏阴性杆菌是 92 例（46.7%）中最主要的分离物。大多数分离株为大肠埃希菌 68 株（61.8%），其次是克雷伯菌属 22 株（20.0%）。大肠埃希菌对美罗培南高度敏感（97.0%），而对头孢曲松、氨苄西林和头孢他啶的耐药率分别为 64.7%、67.6%和 63.2%。克雷伯菌属对美罗培南（86.4%）和头孢曲松（77.3%）、庆大霉素（86.4%）、氨苄西林（81.8%）和头孢他啶（86.4%）敏感。金黄色葡萄球菌分离株对克林霉素 100%敏感。革兰氏阴性杆菌中产生超广谱β-内酰胺酶的比例为 64（69.6%），53.8%的金黄色葡萄球菌分离株对甲氧西林耐药。
结论
在这项研究中，产褥期脓毒症主要由大肠埃希菌和克雷伯菌属引起。病原体对大多数经验性治疗中使用的抗生素表现出很高的耐药性，这需要重新审查治疗指南和严格的感染控制程序。
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